Antibiotic Resistance: We Were Doing Great and then COVID Happened
October 1, 2022
By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: After improvement, antimicrobial resistance in the United States significantly increased.
SOURCE: Centers for Disease Control and Prevention. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022. https://www.cdc.gov/drugresistance/covid19.html
As of 2017, dedicated infection prevention and control efforts in the United States contributed to reduced deaths from antimicrobial-resistant (AMR) infections by 18% overall and by nearly 30% in hospitalized patients.1 But then AMR infections during hospitalization increased by at least 15% from 2019 to 2020 — the first year of the COVID-19 pandemic. Table 1 outlines the increase in resistance among some organisms considered risks.
Table 1. Increase in Antibiotic Resistance Among Some Organisms |
|
Organism |
% Increase in Resistance During Hospitalization |
Carbapenem-resistant Acinetobacter |
78% |
Carbapenem-resistant Enterobacterales |
35% |
Extended spectrum beta-lactamase (ESBL)-producing Enterobacterales |
32% |
Multi-drug-resistant Pseudomonas aeruginosa |
32% |
Vancomycin-resistant Enterococcus |
14% |
Methicillin-resistant Staphylococcus aureus |
13% |
Antifungal-resistant Candida |
26% |
Antifungal-resistant Candida auris |
60% |
A major driver of this increased resistance is overuse of antibiotics. From March 2020 to October 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic despite the fact that multiple studies have demonstrated that bacterial co-infection is uncommon at the time of presentation and is overdiagnosed later in hospitalization.
Overall, however, antibiotic use decreased in 2020, and this was due to less outpatient prescribing. This resulted from reduced use of outpatient healthcare in general and a reduction in community respiratory infections, which frequently lead to inappropriate antibiotic prescribing. Separately, data also indicate that the dramatic increase in telemedicine visits played a role. However, the decrease in antibiotic use was short-lived. While antibiotic use was lower overall in 2021 compared with 2019, outpatient antibiotic prescribing in August 2021 exceeded prescribing in 2019 by 3%.
COMMENTARY
Coincident with the first year of the COVID-19 pandemic, the United States tragically experienced a significant reversal of the remarkable progress that had been made in recent years. The Centers for Disease Control and Prevention (CDC) suggests that among the factors that contributed to this occurrence in hospitals was the influx of very ill patients, staff shortages, and shortages of protective equipment. An example of adverse factors in outpatients included the redeployment of sexually transmitted disease program staff and resources to deal with COVID-19, as well as laboratory supply shortages.
In response to this reversal, the CDC plans to enhance national systems and to ensure uninterrupted availability of laboratory supplies and equipment necessary for both patient care and infection control. The CDC also states that clinicians are encouraged to follow antimicrobial stewardship principles and to participate in infection control training.
Another approach planned by the CDC is urging healthcare facilities to monitor their wastewater as an early warning system for detection of antibiotic-resistant pathogens and to expand the National Wastewater Surveillance System (which currently is being used to monitor SARS-CoV-2). They also will partner with the U.S. Food and Drug Administration and other agencies to facilitate the development of vaccines and antibiotics. Their goals include optimizing all antimicrobial use in all settings.
REFERENCE
- Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
After improvement, antimicrobial resistance in the United States significantly increased.
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